HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LU CM
!j 4 '
R e C' F. r L„ tz -- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 1
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1.578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: J, 00
Property Tax ID #i
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
i
(Affidavit required)
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
iV1echanicai Gas Tarik —Gas Piping SnuLLers _ Winduws/tDuurs _ Purid
Electric Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cott of Constriction: $ Utilit!e5: _ Sewer ___. Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
Name:
Address
Cornnany: 1
City: State: �
Llp Gn.
Phone No —' E-
Address CSIt% 21
•r..ity: �� Jtatl
Zip Code- Z Fax:
Phone No
Mail
Fill in fee s p e Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
0
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State:
_ Not Applicable
MORTGAGE COMPANY: ` Not Applicable
Name:
Add ress:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures; swimming pools, fences, walls; signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
ua,i+k Innelor nr mn nttnrnp„ hpfnrp rnmmencine work or recordine vour Notice of Commencement,
e wner/ Lessee/Contracto Agent for Owner
STATE OF FLORIDA
COUNTY OF '
Swor (or affirm nidvibscribed b#9re me of
Physical Presence or
Online Notarization
thisday of ` by
Na king statement,
•-:
JODI PEPE
Notary Public State Florida
er onall K OR Produced identification
?°
��
- of
{ommisslon r GG 96;585
Type a Identification ProduoFn
Bonded
My Comm. Expires J u r 27, 242a
through Natlonal Notary Assn.
(Signatur ublic- State of Florida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
BATE
COMPLETED
Rev 5/20/21